That's oh-be-GUY-n, not oh-be-GIN, as some (primarily people from Texas) would like to refer to my chosen profession. Although, working in this field can sometimes cause one to develop a penchant for gin...hmmm.

Friday, August 29, 2008

Annoying Things

I think I've been more than a tad touchy these last few weeks, as I contemplate major upheaval in my career and family life, so maybe I am noticing things that bother me more often. Never the less, I am going to post annoying things that people say and do that really piss me off, since it wouldn't be *professional* to say it to their collective faces.

~ Any referring physician (ER, family medicine, pediatrician, all are offenders) that tells their patient with unexplained lower abdominal or pelvic discomfort and a normal exam and ultrasound that 1) "You must have had a cyst that ruptured." or 2) "You probably have endometriosis."

First of all, sometimes, you can just have pain in a certain area with no pathologic explanation. Some people have pain when they ovulate, or right before their period, or when they move the wrong way, or have sex 3 times a day, every day (yes, one patient referred to me for vaginal irritation and pain admitted to this...hmm, wonder why you are so sore???) Second of all, there are a whole bunch of different things that reside in the lower pelvis, including bowel and bladder, both of which can be causes for significant pain in their own right. Why every woman with low abdominal pain must have a "female issue" is totally beyond me.

It isn't that women with pelvic pain shouldn't be referred, they absolutely should be seen and worked up by a specialist. However, I have found that these two phrases mentioned above are physician code for "I have no idea what is causing your pain, but instead of saying that, I'll scare you into thinking you have ovarian cancer or a chronic disease." Because that, my friends, is what the patient hears, and is scared to death until they come see the GYN, so much the better for all involved.

~GYN consultation in the hospital "for pelvic exam." I kid you not. Apparently I have been doing it all wrong, doing my own cardiac exams and lung exams on my patients when I should have been consulting cardiology and pulmonology. How silly of me! What, the patient hasn't had a pap in 4 years, has a broken femur, can't move her hip, and is on her period? Why *don't* we "just do it while she is in the hospital?" Freaking fabulous idea. Thanks, alot.

~"Annual Exams" that really aren't annual exams. By that I mean, I made an appointment for a routine health screen, but what I really meant was that I just had my pap and breast exam at the health department last month, *however* I think my boyfriend is cheating on me, and I need tested for all STDs, and it has made me really depressed (I think it is my hormones), and by the way, I have no libido....can you please fix me in 15 minutes??

~Referrals for a "dropped bladder" (gotta love that technical term) on patients that weigh 350+. There isn't a surgical procedure in the world that can combat the overall gravitational forces working on those bladders. Never mind that most of these patients also have multiple medical problems, making surgery a veritable nightmare to begin with, and if you mention losing weight to help with their incontinence they wonder aloud why you "can't just fix it?" Oy.

~When men come into the exam room with their wives/girlfriends, etc., proceed to speak for them the entire visit, ask to "look in there" when you are doing the pelvic, and then finally, when you have your hand on the door, reveal that the "real" reason they came was because he thought there was something "wrong with her" because she doesn't want sex as much as (the guy) does. Gee, I just can't imagine why she isn't all over you, buddy. Nice.

~People who tell patients (pardon the poor grammar, but this is verbatim) "Just call your doctor if you have a question, that's what they are there for." (or the variation, "that's what you are paying them for."). Actually, your physician is "there" to provide health care and ensure that you (and, if pregnant, your baby) are well.

They are not "there" so you can page them at 1:40 in the morning (this is an actual call here) when you notice that your right breast is just slightly larger than your left, and you wanted to be certain that was "normal." Also, "you" are very often *not* paying your physician to answer after hours phone calls, and neither is your insurance company. They are answering your questions *for free* on their own, scarce, precious home and family time. (Oh, what, you think that answering ridiculous phone calls are just "part of the job?" Then why do lawyers get to bill by the hour, phone call, and email? Why is a physician's time and expertise any less important?)

So quit thinking that doctors are automatons with no lives, that never sleep, who "deserve" to work for free, and live only for the next breathtakingly inane page about your deep ruminations about your inner workings, You're wrong. And amazingly inconsiderate. If you aren't bleeding, losing appendages, or dying, save your calls for office hours, please.

~Finally, the most annoying thing of all...being on call for the whole. long. holiday weekend. There's nothing quite like having someone wish you a great "weekend off" when you know you'll be living at the hospital and fielding midnight phone calls while every other American in the free world is getting their drink on, living it up with parties, picnics, festivals, and sleeping in. Bitter, bitter, bitter am I.

Luckily for me, (and you, I imagine) a change will soon be coming. And not a moment too soon. Thanks for letting me get it off my chest...oh, and have a great Labor Day weekend. Heh. :)

23 comments:

YES YES YES on the ovarian cyst issue. A few years ago Contemporary Ob/GYN had a cover showing an ovary with the headline "Ovaries Make Cysts for a Living". Wish I had framed a copy, maybe one in each exam room. From what I hear from the patients, it would be news to the ER docs and referring docs that ovaries actually produce cysts as part of their NORMAL physiologic function. The belief that an ovarian cyst is significant pathology is rampant. Oh, well, plenty of opportunity for patient education! Thanks, Dr. W!!

I love my OB, actually all of my docs. Reading you has given me such a greater appreciate for all of them!!

I used to feel terrible about calling during my pregnancies when I didn't feel the baby move or had a little spotting and it was midnight. Now, I feel terrible for you and all obs who have to deal with abnormal breast size at 1 in the morning!!

oh yes yes yes. especially on the inane pages. as a family practice doc, lordie, the pages.

"my child has a 100.5 degree fever and I am terrified. Oh, you say that's not an emergency? Well, can you tell me everything there is to know about vaccinations while we are on the phone?" at 2:30 in the morning, I think not. Real caller, I assure you.

or this one: "my 2-week baby has had a fever for 2 weeks. I decided this is an emergency on Saturday afternoon, and I have a pediatrician appointment for a 2-week check on Monday." Turned out they were taking rectal temps (at. every. diaper. change. which I think is borderline child abuse) and *adding* a degree to the thermometer reading, thus decided that the 99.9 temp that resulted was a fever that required my attention. And she would not believe me that 4 years of medical school qualified me to tell her that she was just converting the temp wrong. I swear, I was on the phone for 45 minutes with this idiot.

Also add the people who demand you change their diagnosis so their insurance will pay for their visit. (code problem visit instead of Annual)

Also add people who have stinky feet (don't they realize their feet are right by our noses during an exam) I think you should do a whole post on that topic..... perhaps we could even get awareness bracelets :)

oooh, I hear you. I am a surgeon, and I once got a call at 2 am from a patient who had had a hernia repair a few days before...he and his girlfriend had just noticed that his left nut was higher that the right, but before surgery it was the other way 'round. and just the other day I had a guy come in for a hemorrhoid consult, whose wife came in the exam room with him...I don't argue if he seems ok with it, but I'm sorry, that is weird.

ESPECIALLY the ones who want you to change their diagnosis so insurance will pay for the visit. Whaddya want me to do, make up a problem? I'm an FP and have had to convince people before that there is such a thing as a physiologic cyst (yes, of course you have a cyst, everybody who ovulates gets these about once a month). PS I think men who come with their partners for their pelvic exams are just plain creepy and I have discharged a couple from my practice because they just gave me the creeps so bad.

One of the OB's I work with said that she got a call on a Saturday night about 2 a.m. from a drunk college student who thought she might have a developed a UTI a few days ago. Why she thought it would be a good idea to call her MD at 2 a.m. is beyond everyone. I feel for you guys.

Hey now, no picking on the lawyers :) Just kidding! Your level of patience must be ten times higher tham mine to put up with those kinds of phone calls. I am rarely tracked down at home and if I am it is usually a friend of a friend gave me your number situation. My pediatrician actually does charge more for after hours / weekend visits. I doubt this would do much to discourage those who are going to abuse the system anyway though.Good luck with all your transitions. I had major angst when I decided to go solo, but it was the best thing I ever did and in hindsight I should have done it a lot sooner.Amy in OH

I am enjoying your blog (I'm a new arrival to it). As a CNM, I can totally relate to some of those obnoxious phone calls, not just from patients but also from staff nurses, i.e. "your patient had lates for ten minutes but they went away after I changed her position and the strip looks great now" at 3am. Um, thanks.

Anyway, keep up the good fight, or at least keep blogging as I enjoy it!

As a psychiatrist, I find this the most annoying:"Doc, I can't asleep, I don't know why, I take a few naps during the day, I don't know, maybe seven hours total? But I just can't sleep at night. Can you give me some Ambien?" Good grief! Get a job! Stay awake during the day!

I hope that your next career move is OUT of medicine - you sound incredibly fed up and angry. I hope I never get a doc as burned out as you sound. So sorry that you find that some of your patients do not fit into your ideal. What would that be? Low-need, already knows everything about their condition, pretty much just needs you to write a prescription or something? Gee, maybe not everyone knows what you do - perhaps it's your job to educate them. Or is that also NOT your job?

Doctors have the right, just like anyone else, to get annoyed and frustrated. I will soon be entering full-time ministry. People do similar things to church workers. They forget that ministers also have families and other obligations People want to be respected and treated well but forget that others want to be treated the same way.

Dr. Whoo, best wishes in your upcoming transitions. I pray that your new job will be more supportive and a better fit.

carrie ann, I remember a book about a minister's daughter who said that "Daddy called the people who really annoyed him, 'also a child of God.'" It does help me when people are really on this FP's case to recall that.

I have always wished that my Doc could bill for phone calls. He always calls me with test results as soon as they are in! I understand. I am a consultant and even bill for the time driving to a client - you deserve better!!!

This is way late, but I thought I'd comment on the whole cysts thing. In the ED we are, unfortunately, required to WORK UP those phone calls you get. Yes, they show up at our door and we have to make sure they are not gonna die. Women often get a pelvic u/s (r/o ovarian torsion, ectopic) which turns up cysts. The radiologists report, of course, always reads that this should be followed. Thus, we have to relay that to the patient. Or be responsible for breaking some great chain in the diagnosis of (yet another) ovarian cyst. Also, when we're done working them up (no appendicitis, no UTI, no gallbladder disease, no ectopic, cyst on ovary) we like to give them an idea of what MAY have caused their pain. If we tell them, "Don't know what caused it, sorry, see your doctor" they get all pissy when they get the bill and then our Press-Ganey numbers come back crappy. You know what that means? Well, amongst some of my friends that can mean that their contract won't be renewed. Yup, they'll lose their job over a few shitty PG comments.

Hi Ashley, bless you for working the ER, because to me, it is the ninth circle of hell. However, in my post, I was specifically referring to the patients in whom there were no findings...including no ovarian cysts.

Nevertheless, even when there are no radiologic or physical findings, certain physicians will still just assume that the problem has to be "female" in nature. ie "All your tests are negative, so you must have had a cyst rupture." A fine point, I know, but that really gets my goat. Keep fighting the good fight, and thanks for reading.